Cretinism . Order II . ? Inflammatory : ?

t\v 6S' whatever was the treatment adopted, during an experience of upwards of pnty years. a1"0? the greasy nature of tubercle in its crude state, Dr. Hastings concluded, 8tJ.Carb?n entered largely into its formation, and that its composition had a 0r ng resemblance to fatty matter. Among the changes in the earlier stages ^ Pulmonary consumption, the disappearance of the fat is about the most ret^arkable; in consequence of this loss of fat, the author determined to employ Yj?Se compound agents rich in carbon and hydrogen, which had not been preg .^sly used in medicine; " not with the idea that they would make up the de8 len?y which the system had sustained in the progress of the disease, but that

lin ' AStings states, that the reason which induced him to deviate from that in ^ me(hcal practice, which has so universally, and for so long a time, been Ca v?&Ue, for that which he now brings forward, was the fatal termination of all t\v 6S' whatever was the treatment adopted, during an experience of upwards of pnty years.
a1"0? the greasy nature of tubercle in its crude state, Dr. Hastings concluded, 8tJ.Carb?n entered largely into its formation, and that its composition had a 0r ng resemblance to fatty matter. Among the changes in the earlier stages ^ Pulmonary consumption, the disappearance of the fat is about the most re-t^arkable; in consequence of this loss of fat, the author determined to employ Yj?Se compound agents rich in carbon and hydrogen, which had not been preg .^sly used in medicine; " not with the idea that they would make up the de-8 len?y which the system had sustained in the progress of the disease, but that act a ?hange would by that means be introduced into the constitution as would a uP?n the forces of the organism at the point of departure from health, wheto r that took place in the stomach, blood, or elsewhere;?that change tending **h an affinity in the elemenSs within the body, that the carbon, hydrogen, thr n and nitrogen, instead of assisting in the formation of products which a eaten life, would tend to develope those materials only which are required for e. Perpetuation of health, and the prolongation of existence." ?Accordingly, Dr. Hastings was led to employ naphtha as a remedy in pul-th^y consumption. Many different compounds pass under this name, but kind of naphtha termed pyro-acetic spirit, obtained by the destructive distil-,j-of an acetate, generally of lead or lime, and in its outward form scarcely ke tlnguishable from pyroxilic spirit, is the species which is considered to be the ^ suited for this purpose. , he following is the way in which Dr. Hastings employs the remedy. ati .1 administer naphtha three times a day, in doses of fifteen drops for an a.ult> mixed with a table spoonful of water, which is proportionably decreased cre n? as the patient approaches youth. After the second or third day, I injn ase the dose by about one-fourth; regulating its increase or decrease, accord-t0 t^le absence or presence of nausea, sickness, or any other untoward f0 Ptom arising out of its use. As the disease advances, I increase the dose to tidiesan<^ 6Ven drops, and administer it four times a day, instead of three f8e successful use naphtha, as an internal remedy, induced me to try its foil ? by inhalation, to which I was the more inclined from the results of the ?Wing experiments:? 458 Periscope; or, Circumspective Review.
[Oct-1 " 1st.?A little naphtha having been put into a bent tube, resembling ^ capital U, some expectorated matter was poured upon it, which had De_en, at termined with the microscope to be rich in globules of tubercle. Gentle was then applied, and the naphtha driven off, when the super-imposed secT?TM presented a mere shapeless mass of animal matter, the globules having en 1 disappeared. , je) " 2nd.?Some tuberculous secretion, highly charged with globules of tub? ^ was placed under the field of the microscope, and a drop of naphtha ad when an immediate disappearance of the globules ensued, leaving behind a . n* of the same character as on the former case. The frequent repetition oi experiment, invariably led to the same result.
. ,^e " 3rd.?Some tuberculous secretion of the lungs was put into a portion ox ^ intestine of a child, and placed over a wide-mouthed bottle, which contain^ small quantity of naphtha, between which and the intestine a clear space of inches remained. A spirit lamp was then placed under the bottle, and a * ^ gentle heat applied until slight ebullition took place, which was continued . an hour. The contents, when removed from the intestine and examined * the microscope, presented the same appearance as described in the preV1 experiments. " Considerable benefit resulted from the inhalation of naphtha, in lessen' the difficulty of breathing in the most advanced cases, in rendering muscu efforts less painful and fatiguing, and in a general alleviation of all those syW toms which distress the consumptive patient. The expectoration is not un.jlS quently rather increased immediately after the inhalation of naphtha, but cough has changed for one of a milder character. Improvement was geneT\i, observed to follow that kind of inhalation which was performed with little ex tion. It may be employed several times in the day, unless it produces naVSjp and sickness, when its use should be suspended; and on its being resumed) ^ such cases, it should be applied for a shorter period. When there is spitting blood, its use is not admissible." . ^ " Almost immediately after naphtha has been administered, an occasion rising of the medicine is perceptible in the mouth and throat, similar to t*1 which occurs after a dose of castor oil. This is sometimes followed by nause' and now and then vomiting supervenes. At other times it acts, but much a rarely, as an aperient. But when these effects occur, they usually subside l" day or two. It not unfrequently produces a glow in the region of the stomaC ^ which extends over the chest and creates a sensation of cheerfulness and greater freedom of breathing. It appears deserving a high rank among ton'c ' for in most of the cases in which it has been employed, a natural appetite in a short time established. No remedial agent that I am acquainted with ll0 sesses such power over the colliquative perspirations of pulmonary consUW tion; as a few doses, in most instances, appeared sufficient to effect their * moval. Another fact worthy of remark, is the absence of diarrhoea in all caS J which may be accounted for upon the supposition that tubercular deposit ceas to take place in the mucous track of the intestines. And even in those caS.
where diarrhoea, in the first instance, existed, it readily yielded to the napb* g treatment. The thirty-third case is a good example of this remark. Headacjj' particularly when the bowels are confined, is sometimes the effect of the napj1', e treatment, and if aperients fail to give relief, a mustard poultice shoxil" g applied to the back of the neck, or a few leeches to the temples, or behind ears.
It will, however, be very seldom necessary to suspend the employmen the naphtha from this cause." . 3 According to Dr. Hastings, from the very first moment he employed Nap in Pulmonary Consumption, up to the present time, it has been so successful1' his hands, that he has no doubt it will be found, if used judiciously, to be W IPCC 4" rl IV* n ortflm/i/i m fl-io nnvliny ? di^ recently observed, he is most sanguine that, even in the latter stages of the a restorati?n health may generally be calculated upon.
progress of improvement in the physical signs, when sufficiently p e"? invariably commenced with an amendment of the sounds arising from j^cussion. In no case did they appear to begin by those of auscultation; con-JPfntty I am induced to form the opinion that, as diagnostic signs, those de-?3 auscultation take precedence of those from percussion, or, in other hai' c^ian8es such as prolonged expiration, and very slight feeble and pj r?sPirati?n? may he detected by auscultation, when the sound elicited by sjnCUssi?n is not sufficiently appreciable to lead to any useful conclusion conned apart from auscultation." iany cases are narrated in which the naphtha was employed.
Ho 1 exPer^ence proves the correctness of these statements, Dr. Hastings will, ct?ubt, be considered a benefactor to the human race.  in the brains of the Insane, surely Insanity, if not identic^ with, must be nearly allied to inflammation ? I conclude, therefore, that tn proximate cause of Insanity, is a chronic inflammation of the brain, and hen my reason for placing it in its present position in my arrangement." Moral Insanity is the Pathomania of Dr. Prichard. It consists essentia^ in a perversion of the usual habits and feelings, without delusion. The Patie j is wayward, eccentric, and extravagant in his conduct, but has no proper ment delusion or hallucination.
Hypomania.?This term Dr. H. Johnson proposes to substitute for mono' mania, as signifying a slighter form or lower grade of mania. " In this there1 delusion, on one or more subjects, connected or unconnected. Sometimes tn delusion is very persistent, sometimes it changes from day to day. The Patie,? is, however, not violent, nor unmanageable. He has not the furious look 01 maniac, but has more the appearance of a person in ordinary health." Dementia.?This, in its last stage, fatuity, is characterised by the annihilat'0? of the mental powers : it is to be distinguished from idiotism, by its not bein? congenital. It is usually the termination of mania. Dr. H. Johnson thin? that a new name, to be derived from the Greek language, might be advantage ously substituted for the present one; he is, however, unwilling to suggest any unnecessary innovations of this kind.
Delirium.?This is classed amongst the non-inflammatory affections. ^ author looks upon delirium as always a symptomatic affection, depending up0 some disease going on at the same time in the system. It appears to depend 0 an anormal condition of the circulation within the brain.
Hypochondriasis.?" This is chronic dyspepsia, attended with peculiar lown??? of spirits, desponding habits of mind and undue attention to every uneasy bodn; feeling. It is easily distinguishable from Insanity by the absence of any del11' sions, and by the prominence of the dyspeptic symptoms. It is said sometim6 to lapse into Insanity, but this is not a frequent occurrence. The disease see# to commence with irritation of the organic or ganglial system of nerves, and irritation is propagated by a species of reflex operation, first to the brain, VT?' ducing the morbid state of the feelings, so characteristic of the disease, and fr?
*843] The Iodated Waters of Heilbrunn. 461 Ho s?resides in the vicinity of a Spa which will probably take rank with Kis-r^n, Marienbad, or even Carlsbad, before many years. bet -6 v^aoe ?f Heilbrunn is situated in a romantic spot in Upper Bavaria, I he Q11 ^ecken"Tolz, and Benedictbeuren, eight German miles from Munich, old Heilbrunn rises between two eminences, and is said to be the , est of all the Bavarian Spas. In 1659, it experienced a piece of good fortune, S Contributing to the increase of the Elector's family, and its prolific virtues Th 6 Sp.ee(% bruited about among the ladies, so as to establish its reputation. Neighbouring monks, however, became jealous of the Spa, and nearly a r, *t, till, after nearly two centuries, (1805,) its renown was again revived by fe eri?an physician, (Graff,) who wrote a book on the waters. In 1825, Pro-of^Vogel was employed to analyse the water, and he discovered the existence cojl?ye *n the spring. This was afterwards corroborated by Wetzler. In (v Pliment to the Queen of Bavaria, it now received the name of " Adelheid j) "e following formula employed by Struve at Berlin, is supposed by Sir A. ?^nie, to be as nearly as possible, the analysis of the Spa in question.
( . It appears to be plainly and sensibly written, containing much important 1 formation, condensed, without producing obscurity, into a small space. ItlS' . course, quite impossible to give any analysis of such a work, but we may extra the following history, drawn from the observations of Orfila, of the process ossification as a means of determining the age of the dead.
., " At 2 months, ossification of the os magnum, os cuneiforme, and os cuboid ? " At 4 months, ossification of the branches of the os hyoides. " At 5 months, ossification of the lower apophyses of the os hyoides.  Ossification of the trapezius and lunar bones, formation the ethmoid cells, and bony union of the body and processes of the second ce vical vertebra.  e$p . le state of the osseous system will also furnish some clue to the age, hicf Cl% during the latter periods of life. The internal cavities of the bones s *ase, from j]ie absorption of the osseous matter, and the bones from the aCc e Cause become lighter. The bones of the head are solidly united, but, on sWiUnt of the absorption of their diploe, become thin. The lower jaw becomes tusl 5 alveolar processes are absorbed, and the angle again becomes ob-Wv 3 in childhood. The spinal column is curved. The cartilages of the dejjrx a?d ribs are completely ossified. The osseous tissue generally is more tUor and fragile, and abounds in earthy materials. In advanced age, e?ver, the heart and arteries become more or less extensively ossified." The Vital Statistics of Sheffield. By G. Calvert Holland, Esq. M.D. V.
.ls a very elaborate work on the statistics of the town of Sheffield, more ^bit y as bating to the several branches of manufactures, the condition and Sojj. s the workmen, and various points of local interest. We will extract e ^marks on the fatal effects of " dry grinding." 464 Periscope; or, Circumspective Review.
[Octlife Fork-grinders.?This occupation is perhaps more destructive to human w than any pursuit in the United Empire; it exceeds, however, only in a few' ^ grees many other branches of grinding. Fork-grinding is always perform?11 a dry stone, and in this consists the peculiarly destructive character of_ 1 branch. In the room in which it is carried on there are generally from eigM ten persons at work, and the dust which is created, composed of the fine P., tides of stone and metal, rises in clouds and pervades the atmosphere to wn1 they are confined. ,g " The dust which is thus every moment inhaled, gradually undermines vigour of the constitution, and produces permanent disease of the lungs, acc0{a panied by difficulty of breathing, cough, and a wasting of the animal frame, ofte^ at the early age of twenty-five. Such is the destructive tendency of the ocd1 pation, that grinders in other departments frequently refuse to work in the satf room, and many sick clubs have an especial rule against the admission of grinders generally, as they would draw largely on the funds from frequent ai> long-continued sickness." The mortality is tremendous. To form a proper idea of this mortality, it is necessary to compare it with t ratio of deaths at different periods in other classes. " Thus in 1,000 deaths of persons above 20 years of age, the proportion tween 20 and 29 years, in England and Wales, is annually 160. In Sheffie'' 184; but among the fork-grinders, the proportion is the appalling number 4' ' so that between these two periods, three in this trade die to one in the king"0 generally. *n " Between the ages of 30 and 39, a still greater disparity presents itself-' the Kingdom, 136 only in the 1,000 die annually between these two PeT qg In Sheffield, 164; but in the fork-grinding branch, 410; so that between * and 40 years of age, in this trade, 885 perish out of the 1,000; while in 111 kingdom at large, only 296. Another step in the analysis, and we perceive tb?
between 40 and 49, in the kingdom, 126 die: in this town, 155; and in ^ branch, 115, which completes the 1,000. They are all killed off". For in carO" ing forward the inquiry we observe that between 50 and 59, in the kingd0^ 127 die; and in Sheffield, 155: but among the fork-grinders, there is n.? single individual left. After this period of life, there are remaining in the k^J dom, of the 1,000, 441; and in the town, 339; but none in this branch 0 manufacture." In 1841, ninety-seven adult workmen were employed in this trade. Of ninety-seven, about thirty are at this moment suffering, in various degrees, fr? the disease peculiar to this occupation, viz. grinders' asthma.
f " The disease is seated in the lungs and the air-passages, and the progresS it is accompanied with the gradual disorganization of these important org?n ' In its advanced stages, it admits neither of cure nor of any material alleviat10 ^ In the early stages, the only efficient remedy is the withdrawal from the influ^. of the exciting cause; but how is this to be effected by men who depend fr0' __ day to day upon their labour, and whose industry from early life has been fined to one particular branch ? Here, then, is the melancholy truth, that near^ one-third of this class of artisans, in addition to the poverty and wretchednecommon to the whole, is in a state of actual disease?and disease which no a can cure. deal ^rst these, the appearances on the surface of the body varied a good 0r '.In the greater number of cases, however, there were large dark petechia?, litti-1'Ces' esPecially about the clavicles and groins. On cutting into these, Ho 6 anything was found to account for the mark so apparent on the surface; extravasation was detected in any instance. In the head, chest, and abdoiri vi.1 may he stated generally that nothing but congestion, varying in degree ^as -rent cases> was found. Ce to become stationary, in fact it rarely went on to form abscess. The \V"fuS *n these cases was excessive. cUlari regard t0 the condition of the internal fauces, two affections more parti-eW^ame under Dr. Kennedy's notice, viz. diphtherite, and oedema of the UuqjI8' Both of these were accompanied by ulcerations, varying in extent and With "6r thus there was very constantly one in the upper part of either tonsil, the ,lrregular edges, and of considerable depth. Ulcers were also found about rdse vocales. s some cases, when the patient was to a certain degree convales-ce^ was found that the child's neck had become crooked, and that when any xT Pt was made to bring the head straight, it caused severe pain referred to N?? LXXVIII. [Oct.
1 the upper part of the neck, and commonly to one side. This may have ari^' in some instances, from the inflammation of the throat spreading to the neir> Louring textures, so as to engage those of the spine, and sometimes in ^llsAjje cause caries : in other cases it occurred where there had been swellings oi ^ neck, with the effusion of lymph, this effusion taking place about the muscles of the nape of the neck, and sometimes in the upper portion oi trapezius; it was attended with some pain on pressure, and was very d" je5 to remove.
In a third set of cases it arose from a spastic state of the ibu*c on one side of the neck, more particularly engaging the sterno-mastoid, a i r. peared to be caused by the patient lying in one position in bed for a consi" able period.
. w Another sequela of the disease consisted in the inflammation spreading the Eustachian tube, and so reaching the internal ear, causing abscess a*101 .3 foliation of the small bones. At other times, an abscess formed in the par0 region, and burst into the ear.
0f Purulent effusion into the joints was another and most formidable sequfla. f this epidemic. Sometimes only one of the large joints was attacked, at 0 times three or four were found to be full of pus. The synovial membrane \ commonly healthy, though at times it was found intensely injected and c?a with lymph. The same remark may be made of ulceration of the car fni In some very severe cases, the [epiphyses separated from the shafts of the ' bones. The internal organs were not affected in these cases.

?
The milder forms of the disease were frequently complicated by 'nterflSt lesions. Of these the attacks of the chest were the most frequent and 111 } serious. Dropsical effusions were also often present. In these cases, general rule, the kidneys were quite healthy, whether the urine was or was , albuminous. In other cases again, great congestion of these organs exis sometimes to so marked an extent, that it appeared to have enlarged the ki('n J, In three instances, one of the stages of Bright's disease was very well mar J the kidneys were a good deal larger than natural, and their texture soft; j when the fibrous coat was taken off, the surface was distinctly mottled a" from the deposition of lymph.
Symptoms.?The invasion of the disease was generally sudden, the symPt0S.
being commonly referred to the stomach. The stage of collapse rapidly ' it lowed, marked by its usual symptoms; there was seldom any distinct rig^'j was more of a creeping or shuddering, and often existed with a warmer sta{ (i) the surface. The average duration of this stage of collapse was from five hours, when reaction set in, and the more prominent symptoms of ^,efr0n1 ease made their appearance. Sore-throat was constantly met with, varying ' ^ simple redness to the most extensive sloughing. Chronic enlargement ? tonsils, and an unnatural redness of the throat, remained for an indefinite ^ in some cases. The tongue very frequently did not present the usual apP j, ance said to be so characteristic of scarlatina. The pulse was usually 111 jj quickened; during the stage of collapse, it was weak and indistinct; from eight to twelve hours it had again developed itself, and was to be ^ ranging close to 120. From this period it steadily declined in strength about the fourth day, when (supposing the patient did well) it again beg90^. improve in tone and vigour, and its frequency became lessened. In t]l0S\eii stances where the disease was more like a plague than scarlatina, that is ^v.{3t there was little if any reaction, it at times happened that no pulse could be if jts the wrist for several hours before death. The eruption varied considerably intensity; in its most severe form, it was in one continuous sheet over the^'.^t surface. In other cases, it presented itself in great patches of a very VTfa colour, as large as one's hand would cover, but which were entirely sepai"31?^ from the other. In both these cases spots of purpura occasionally appeared ? l84o] Contributions to the Materia Medica. 467 to the general eruption. If the eruption appeared in the following manner, the 1Seas.e Was sure to prove of a very severe form. " A case would occur in which H0t ^ruPtlon of the common character had come fully out; it might or might ap favourable, but on the following day an additional crop would make its the fj>arance; this was usually of a brighter colour, and much better defined than lrSt: anc* what was curious about it was, that this last eruption might disj r again, leaving the skin only covered with the first." c]a . 1many instances nothing but large dark petechise were visible about the liml S anc^ inSuina' regions, often running down the inner side of the lower p0rt-8-Sometimes there was merely lividity of the hands, feet, and depending skin 01fS ^ie trunk. 111 many cases, where there was very little eruption, the re(j ?t the hands, particularly where the nails join it, assumed a very peculiar nd shining aspect, without any swelling. These were all very severe cases. Ver -S a ^eneral rule, the fever presented either the irritative or the typhoid form; } rarely indeed was it of the sthenic inflammatory type. Coinplex and confused manner, where for every symptom a remedy stood rea"aPer, and where possibly one, two, or more remedies became ineffective by fr0l^n ?f mutual decomposition, or else exercised an entirely different effect as ^ at intended; but now medicines are ordered in a form as little complex eSsZ??sib.le> or even in a simple form altogether. Still, notwithstanding this the i!al hnprovement in the writing of prescriptions, it sometimes occurs, that 8ej Physician, deficient altogether in a knowledge of chemistry, unfortunately troy s the few remedies he employs in such a manner, that they chemically des-^Pect^ ?^er' an^ act either not at all, or in a different manner from what he the p^ePe.n<^ently ?f the inconvenience hence resulting both to the patient and I)rUd(Ure *n ffeneral, but which may be soon discovered and again rectified by a sifJer ^ Physician well versed in the practice of such cases, we must now con-Cfefj.,-ariother inconvenience of a far more serious import. The recipe is in a Cjtty ^Vay the only written document, which the physician gives to the apotlie-tUe^t rthe public at large with respect to his conduct and mode of treat-?fhe apothecary soon sees the faults committed against the laws of che-,vhet>, nity> and the public must observe them, when the medicine obtained, the fixture, solution, &c. exhibits entirely different properties from what ysician assigned it. Now, though the apothecary is sometimes so com-H H 2 468 Periscope; or, Circumspective Review. [Oct.
1 plaisant as to take the blame to himself, this however does not always happe > and the physician necessarily loses in character. g.
The study of chemistry, considered from this point of view, is urgently nec ^ sary to the physician for daily use; but it embraces a field far too extensive be acquired with anything like facility. Hence it occurred to us, that so general rules may prove not unacceptable, which may serve as a clue to ena. practitioners to shun those gross chemical blunders in the writing of prescr I tions.

SUBSTANCES MUST NOT BE PRESCRIBED IN SOLUTION WHICH
ARE INSOLUBLE.
a. The Aqueous Solution. As the aqueous solution is the most usual, the most frequent errors are c? , mitted in this instance. It is known that water dissolves the so-called solu salts, extracts, gum, sugar and soaps, not resins, oils, fats, balsams, camp11 ' nor sulphur, phosphorus, iodine, calomel, &c.
.. ^ With respect to the salts, or saline combinations, it is necessary to exh1 some which are insoluble or nearly so, though they are still prescribed in ^ form of solution; we must, however, impart to them solubility by means other salts which are soluble; in cases of this kind errors are not infrequen ; committed.
The following substances are insoluble, or nearly so :?
Of the combinations of iodine and bromine, those of iron are readily soluW^ the same may be said of the iodide of zinc?iodide of gold is insoluble-"1 ^ perbromide and protobromide of mercury are very difficult of solution?the per' iodide and iodide of mercury are insoluble. . ..
With respect to the solution of extracts, it should be observed, that this ^ perfect in but few cases; partly beca\ise the extracts become changed, an" . part is rendered insoluble by its combination with oxygen, partly because tjw contain resinous combinations, especially if they have been prepared by meil ^ of alcohol; in these cases the solution is turbid, being partly of a brownish, an partly of a greenish colour. alcohol. The fatty oils mix with the ethereal oils; they also dissolve cam-!i-?[> sulphur, and phosphorus; in aether they are readily soluble, in alcohol but \vly soe i a substance is given in solution, the most indifferent solvent must be Ployed, lest, when a full dose is to be administered, the action of the solvent ?uld predominate.

2-NO SUBSTANCES SHOULD BE PRESCRIBED TOGETHER, WHICH
MUTUALLY DECOMPOSE EACH OTHER. c ^his is a principle which may easily be defended, but it is one which must nu a stumbling-block raised by usage. But why do we not endeavour to re-?Ve this block by the aid of science, a block, too, not set up by justice, but by . e,re custom ? Were there no re-action in science, we should make no advance, Use and authority, however badly grounded, would become laws. We do Q0t Wean to say any thing here against the black and red wash, nor against . oulard's mixture, and several other preparations of that kind. These are usepreparations in the cases where they are indicated. We here intend to guard !^r readers against those unchemical formula; where the intention, as well as the fiaracter, of the practitioner simultaneously suffer.
lowing general rules may probably serve many a practitioner as a clue, herein it is to be remarked, that in reference to the medicine which is to be Prescribed, and that which is to be avoided, a reciprocal relation always natu-% exists. When salts of baryta, of lead and of lime are ordered, sulphates and free sul-{ji^ric acid are to be avoided, as the sulphuric acid yields white precipitates, f cult of solution with salts of baryta, of lead and of lime. " hen salts of silver and salts of lead are prescribed, the hydrochlorates and hydrochloric acid are to be avoided as the chloride of silver is insoluble, ^ the chloride of lead is difficult of solution.
"^hen metallic salts are prescribed, care must be taken to avoid:? a-Combinations of sulphur, especially those that are soluble, as sulphuret of j/^ssium, or of ammonium, as the insoluble black or yellow, or reddish-coloured f>etallic sulphurets are precipitated. Even when both the metallic salt as also CorT ? tlle metallic salts yield with the extracts, which, with few exceptions, a certain quantity of yellow colouring matter, insoluble, flocculent, ^fc-brown or black precipitates. These are particularly marked in the salts 4J0 Periscope; or, Circumspective Review. [Oct.
of mercury, gold, silver, lead, copper, and iron, so that, ordinarily, if 1 / quantity of extract is sufficiently great, the entire metallic salt is decompose* In the case of mercury the precipitate is dark-brown, in that of gold viol brown, in silver brown, in lead a dirty brown, in copper a green brown, and ^ iron black. The narcotic extracts act of course in the same manner. combination of acetate of lead, chloride of mercury, or nitrate of silver, wi opium or extract of aconite, we must always expect a portion of the metallic s to enter into combination with the extractive matter and with the vegetable aci of the extract. Usage sanctions such formulae, but the physician can ne} account to himself to which combination he is indebted for the favourable ette ^ produced in the case under treatment; in a fomentation, in an eye-water, con sisting of acetate of lead, and tincture of opium, it may be that the acetate o lead does not at all come into action, but the acetate of morphium, the niec0ll^j1 and the tannate of lead may be the real agents; the same thing holds good Wi respect to the composition of the collyrium, consisting of sulphate of zinc a ^ acetate of lead, wherein the insoluble sulphate of lead is formed, and an acetate zinc continues in solution. If the practitioner attain his end with this, so mu the better. Only if he proceeds rationally, he should know, which substanct produced the effect. e. Soaps. Soaps are decomposed by the metallic substances; combinatjo of the metallic oxides with the fatty acids are separated: this is more especia > to be kept in view in the salts of iron, lead, and copper. To order insoluD metallic combinations with soaps, is not at all warranted. . . f. Vegetable mucus. It is the salts of lead and iron, more especially> W"1 combine with the mucus, forming insoluble gelatinous masses. ,.
In ordering free or carbonated alkalies or earths, the free acids must avoided, unless in the one case of effervescing mixtures. Saturations shou contain a slight excess of free acid rather than of carbonated alkali. Certa* extracts, and those especially rich in salts, but above all extr. aloes cum ac>( j sulphur, in like manner, decompose the carbonated alkalies, or the ammoniac ^ combinations formed sometimes by their being kept for a long time in consi"er' able quantity, are broken up, and ammonia is evolved. Hence, in prescriblDj> pill-masses, in which carbonated alkalies and vegetable extracts, as the extraC, taraxaci. card, bened. absinth, or the extracts of narcotic plants are contain^' great caution is required. The pills in which this action of the constituents otl each other, and the development of a gas takes place, become after a time la#e and larger, and may swell from the size of a pea to that of a small hazel-nut-In ordering sulphur combinations, more especially sulphuretted alkalies (slj phuretum potassse) free acids or acid salts must be avoided. But it must considered that in a neutral fluid an acid may be generated through fermentati0 j . and particularly in substances containing sugar, as for instance in the syrup white poppies. This circumstance merits particular attention when ordering 1 ^ kermes with sugar as a linctus. If an acid is generated here in consequence fermentation, the golden sulphuret is decomposed, sulphuretted hydrogen 1 formed, and an antimonial oxide, which acts as an emetic.
It has been already mentioned that in ordering sulphur combinations ?e j,e salts in the reguline metals must be avoided. In this respect it is only t0. < remarked in the case of pills, that we must avoid directing, that the pills in sulphur combinations exist be covered with gold or silver leaf, as in a little tn? the metallic covering becomes black.
. With respect to the ordering of metallic salts, very different in reference bo to their action and to their chemical habitudes, as for instance, of the chlorMic of gold, nitrate of silver, acetate or sulphate of copper, acetate of lead, chl?rl,g of mercury, &c. cautions have been given in the foregoing observations. 1 these substances are frequently ordered in the form of pills, but when decomp sitions are to be avoided extracts must be shunned, conformably to the expe ments which I have formerly instituted on this subject, I propose as a pill*013 Porti?n of water. When there is no reason to apprehend that the metallic s will act prejudicially on the organs of deglutition, the form of powder seems Co .adviseable, and the saccharum lactis then appears to be the most appropriate stituent; however, in the case of corrosive muriate, chloride of gold, or the?ate s'^ver' ^ie pdular form should be preferred. In solutions, however, to Se Metallic salts, at least with respect to the eye, act still differently in reference Vegetable matters from what they do in the pilular form. An infusion of one {"ce ?f chamomile flowers with 10 grains of acetate of lead or nitrate of silver and tW?-Parts> one a precipitate, wherein is the metallic oxide as a metallic salt, for a therein there is little more than water. These purely empirical m'Sht probably be exchanged for others more judicious and rational, r 11 Would be better, if physicians would make themselves acquainted with the 0r ies they order, (in the above case the combinations of the acetate of lead f nitrate of silver with the organic, extractive and other matters) as they know, j 'stance, in the unguentum ext. decub. antenr., that it is not the acetate of Y and yellow matter, but the tannate of lead that acts. ordering the vegetable alkaloids thexanthic acid and the vegetable substances gaining yellow colouring matters must be avoided, as there are then formed soluble combinations ; hence it is, the substances containing yellow colouring jitter are the most appropriate antidotes in cases of poisoning with the vegetable jn, ?ids. In the same case also iodine must be shunned; this too enters into Soluble combinations.

1
The other saturations may be filtered, in which case however there is a loss of carbonic acid. , The combination of calomel with chlorine-combinations, more especially hydr chlorate of ammonia, is frequently productive of mischievous consequence > which is assigned to the formation of corrosive sublimate; this is possible throug the medium of the vital process ; however it has not been demonstrated by vestigations that have been made on the subject outside the animal body, the contrary, the combination of calomel with the so-called absorbent eart > as carbonate of magnesia or prepared chalk, seems to act prejudicially rather tna beneficially, as by these carbonated earths carbonate of mercury is formed, whic is obviously more energetic than calomel, and acts differently from it. , g Some metallic salts are decomposed in consequence of the accession of oxygen of the atmospheric air, and especially in the aqueous solution ; this chiefly with the salts of iron, as the chloride of iron, lactate of iron, and t ioduret of iron. To prescribe these substances in the aqueous solution is n advisable; their mixture with sugar-juice is to be recommended in preferen > and equally judicious is their exhibition in powder with sugar of milk.
,, g It is scarcely necessary to mention that deliquescent salts in powder should ordered not in boxes, but in bottles. Such are more especially the salts of p?taS ' the tart, tartarisat., tart, ammoniat., potass, carb. etc.
To mix ointments with aqueous or spirituous fluids is possible only to a cert i ^ uantity; if the quantity of the aqueous or spirituous solution is too grea .Ve linim. sapon. comp. with an ointment, as the former substance is a solution soaps in spirit, whereas, on the contrary, the liniment, ammon. blends very ^ with ointments. If it be necessary to combine a great quantity of aqueous spirituous substances with ointments, we must use the liquor ammoniee caust1 as a connecting or binding medium, and partly saponify the fat. j In ordering phosphor, liniment, or ointments containing phosphorus, caution is necessary that the solubility of the phosphorus in the fat be not ove rated, otherwise particles of phosphorus continue undissolved, which may fire on being rubbed in. One ounce of common fat dissolves from six to eigD grains of phosphorus. t It is scarcely necessary to mention that when ordering eye-salves one caO?? be too cautious with respect to the fatty acids of the salves ready prepared iu tDn shops, which often baffle the best intention of the practitioner; for this reason extemporaneous base of the salve should be selected, one prepared from ahno11 oil or wax. In ordering combinations of iodine, especially the iodide of p?ta sium, the fatty acids must be avoided.
A Treatise on Mental Derangement. By Francis "Willis, Second Edition.
Dr. Willis states that, the attention of the public having been of late directed to the treatment of the insane, more particularly as regards restrain non-restraint, he has been induced to re-consider the observations published him many years ago on the " Cure of Mental Derangementthe result is> J he is firmly convinced not only of the efficacy, but also of the necessity restraint in the management of insane persons.
However agreeable, he says, the idea that a system of kind and watchful ment is only required, he feels convinced that this will not alone avail.
minds of the insane must be operated upon by control, either in fact or iu * j The greater number may, and certainly ought to be, rendered tractable wit bodily restraint; but we must attribute the orderly behaviour we are able to P 1^43] Unc^er the care ?f those, whom they soon find they must obey, by being "ged, from the first, to take their meals and their exercise, to go to bed, and to pet up at the appointed hours; and, but for this fortunate circumstance, we should aye great difficulty in keeping an otherwise ungovernable patient in a state of "u*et subjection." yr. Willis is of opinion that it was to the early and prompt adoption of resaint that the great success of his grandfather is to be attributed; and to follow-, 8 the same mode of treatment he feels indebted for having been himself equally 0rtunate. Notwithstanding the outcry raised against restraint, and more partiujarly against " those beneficial auxiliaries, the waistcoat, the chair, and the and gloves," he does not shrink from upholding them, believing it is the "Use of these, and not the use, which ought to be condemned. ' The public, surely," the author says, " cannot know what these restraints j ei against which so much prejudice is attempted to be raised. A strait-waistcoat s only a sort of jacket, made of any strong material, as stout drill, with very ,?ng arms and strings. When applied, the arms are folded over the chest, and behind. It takes full possession of a patient in the most lenient way pos-^ble, enables us to give him food and medicine, and prevents his doing mischief J? himself, or to those who attend upon him; and, if judiciously applied, may e ^orn by the most delicate female without the slightest injury.?As to the chair, J?y strong chair with arms, so contrived that a patient cannot upset it, may be 'designated, ' the chair,' and is more particularly required when the patient is |?? restless to sit down, and would otherwise exhaust himself by standing. The )elt and gloves, or the gloves alone, are a very useful as well as a very mild mode restraint, and a good substitute for the waistcoat in those idiotic cases, in ^vhich the patient has a propensity to pick holes in his flesh, or pinch himself, or Pull to pieces whatever he can put his hands upon." In short, he concludes *hat their use ought rather to be extolled as a mercy, than denounced as a egradation.
? Dr. Willis conceives, also, that the late legislative enactments regarding the 'inspection of lunatic asylums, are calculated to increase considerably the numbers the insane. Patients recently attacked, he says, are " grievously pained by he visitation, perhaps so seriously affected, as to have their recovery retarded or Prevented altogether. What can be more heart-rending to a delicate mind than 4/4 Periscope; or, Circumspective Review.
[Oct. 1 Dr. Willis concludes by asserting that, as his practice has been principal confined to the affluent, his adoption of restraint cannot be ascribed to the wan^ of means in providing adequate assistance in carrying out the most vigilant sitf" veillance; but it is from a thorough knowledge and decided conviction of 1 peculiarly salutary effects that he most conscientiously recommends it, an^ strenuously urges the superiority of positive restraints over every kind 0 superintendence or watchfulness whatsoever.
i " I am aware that I cannot expect by my observations to remove deep-r??te prejudices ; but I may hope that reflective and judicious men, who are not then1 selves practical, and are anxious for information, will weigh the arguments her brought forward before they suffer themselves to be carried away with the stream> and yield their better judgment to theorists and philanthropists in opposition t? practical experience." , It will be seen that the Doctor is a most decided opponent of the system Dr. Yenables considers, that the chemical agencies of carbonic acid may be ren* dered extensively subservient to therapeutical pharmacy, from its capabilities o rendering some of our most powerful and active remedies soluble, and thus plaCj ing them in the circumstances most calculated to increase their energies, aIlC insure their therapeutical agencies to the fullest extent and in the highest degr^j Though some of the neutral compounds of carbonic acid, such as the carbonate alkaline earths, are wholly insoluble in water, yet water impregnated with caf' bonic acid will now prove a solvent. It is, however, principally to the prepay* tion of proto-carbonate of iron, as a therapeutical agent, that our author s attention was directed. " Carbonate of iron, though insoluble in water, yet was found singularly effica' cious as a remedial agent. It is, however, a principle in pharmacology, that ?| general the power of remedies is not only exerted more quickly, but render6 much more active by solution. Therefore, to effect the solubility of the car' bonate of iron forms an object of special moment. The salt, though insoluWe in mere water, readily dissolves in water strongly impregnated with carbon'^ acid gas. This property consequently enables us to give steel under the nmc more grateful form of an effervescing chalybeate. This is effected by mixifle together the equivalent proportions of sulphate of iron and carbonate of potass* or of soda, for decomposition and the generation of carbonate of iron. If carh^' nated water be drawn upon this mixture, decomposition will ensue, and the generated carbonate of iron be held in solution by the excess of carbonic acid-In this state it is fit for use. " In the above process it is evident that with carbonate of iron we will haV? also sulphate of potass or of soda, as the case may be, owing to the mutual transfer of acids and bases. Notwithstanding that the quantity of alkaline sal_ts> generally speaking, will be small, yet even so their presence is often a great in' convenience?sometimes even wholly inadmissible; yet under these circu?" stances they cannot be separated. It becomes therefore a question of some im* portance whether we can easily prepare an effervescing chalybeate, free from aU other saline contamination. By the aid of the carbonating apparatus, this tS practicable, and both easily and quickly. " Carbonic acid condensed in water speedily attacks iron, forms it into car-
. nate and dissolves it. If then a small coil of iron wire, harpsichord wire for stance, be introduced into the pressure flask before its connexion with the appall u.s; and the flask be now filled with distilled water, impregnated with cara?nic acid under strong pressure, and allowed to remain so for some little time, .Pwfectly pure effervescing chalybeate draught will be obtained. Or if some . filings or wire be placed in the water in the condenser, as the water becomes in PreSnated with the acid, the iron will be converted into carbonate, and held solution, which will be ready for use the moment it is drawn off from the PParatus." *,.
? ^enables states that he can, " from experience, assert that there is no Reparation of iron so mild, so active, and so decidedly suitable as a chalybeate, ti Co1nSenial to the animal economy, as the proto-carbonate of iron, held in solu-11 by an excess of carbonic acid gas. If the digestion be impaired, provided ere be no inflammatary action, the above preparation will be found to exert ?nsiderable influence. Should the blood be impoverished, and deficient in the j particles, this preparation will restore it to its healthy condition more effect-% than any other. If we observe its action upon the pale and ansemious leu-?phlegmatic habit, we are often astonished at the rapid improvement, and the et,Hrn of health and spirits." ? ^he apparatus employed by Dr. Venables is Bakewell's patent portable aerat-S apparatus, a description of which is given, with instructions as regards its Se for the preparation of aerated waters, lemonade, and the factitious com-P?unds, &c. of carbonic acid. A long list is added, of diseases in which carbonic :and its compounds may be administered with advantage; beginning with l0Pathic fevers, and ending with incontinence of urine.
Tactical Remarks on Gout, Rheumatic Fever, ani> Chronic Rheumatism of the Joints. By Robert Bently Todd, M.D.
Th" ?is work contains the substance of the Croonian Lectures delivered by the thor during the present year.
\he object which the author has had in view, he says, is to place in juxtaposition the leading facts in the Natural History of Gout and Rheumatism, in i T^er to direct the attention of practitioners, in a moie especial manner than has ttherto been done, to what he conceives to be their true pathology.
-The work does not profess to give a complete history of these diseases; on e contrary, many details of symptoms, aetiology, and treatment, have been prposely omitted, as irrelevant to the argument, the design of which is, by con-.rasting the phenomena of gout and rheumatism with those of diseases confessedly caused bv a morbid state of the fluids, to claim for them a similar ngin.
3 ^ e will proceed to notice a few points. p.
Ow, the Gouty Paroxysm, developing itself in depressed States of the System.? Todd relates several cases tending to prove that, under certain circumstances, eeble, or even exhausted condition of body, the very opposite indeed to that [Oct. 1 took colchicum for a time. On his recovery he was directed to pursue a plan diet, taking animal food in moderation, abstaining from malt liquor, and usino wine in very small quantities. In the course of three or four months the gentlej. man had as many attacks of gout in the same toe. He had carried the plan 0 regimen too far; he had become a teetotaller, and frequently avoided takiM meat; the consequence was, that he had become thin, pale, and enfeebled, and muscles soft and flabby. He was recommended a good diet and tonic remedies, the gout left him, and he has not had an attack for two years. . Dr. Todd remarks, that he has noticed a peculiarity belonging to most of 111 cases of this kind that he has met with, namely, that the urine does not exhi"1 the abundant precipitate of the lithates which so often accompanies the goUJ paroxysm. In some instances there was no precipitate at all; and in others j was very slight. The specific gravity of the urine was rather below than abo^ the ordinary standard, indicating that no excessive quantity of either urea 0 lithic acid was held in solution.
_ . " We learn, from such cases, two useful cautions. The first is, that in. t treatment of the gouty paroxysm, we should be careful not to reduce the patie" too low, lest a new paroxysm be induced. And secondly, that in the treating of patients of the gouty diathesis for other diseases, we should be careful t avoid carrying the antiphlogistic regimen too far, for fear of exciting a fit the gout." Heart-disease occurring in the Rheumatic Diathesis.?Under the influence o cold, imperfect nutrition, or defective assimilation, the constitution is liable to 0 so modified, as to take on what may be called the rheumatic diathesis. This stat Dr. Todd has observed to occur chiefly in children and persons under the age 0 thirty: seldom beyond that period, except where the diathesis existed in early We* " It is characterized by the existence of a febrile state of the system, various!; developed in different individuals, and indicated by quickness of circulation, ?c' casional exacerbations evinced by heat of skin and perspirations more or le?s profuse; the perspirations having a sour odour. The urine is prone to development of lithic deposits, more or less coloured. These symptoms, ho^' ever, often escape the patient's observation (although readily detected by the at" tentive practitioner), and his chief complaint is of pains in the joints, not alwaj's occasioning swellings or enlargements, but often impeding motion; pains alsojB the muscles, or in the course of the nerves of the limbs; not stationary,butnoflr affecting one limb or joint, and again another. The real nature of these pai?s is, I believe, often overlooked; and when they occur in children they are fr?" quently regarded by nurses and others as due to the rapid growth of the chi^' and are popularly called ' growing pains.' " This diathesis is also distinguished by marks of deranged nutrition. There a cachectic appearance; the patient is thin, languid, keenly sensitive to viciss1' tudes of temperature.
In this state of constitution, the heart is apt to become affected; and the dis* turbance consequent upon this lesion may often be the first circumstance to e*" cite the attention of the patient or his friends. The pericardium occasionally' but more frequently the endocardium and valves of the heart, are the par.ts affected. Dr. Todd has so frequently met with instances of diseased heart in young persons labouring under the rheumatic diathesis, but who have neve had any actual paroxysm of rheumatic fever, that he cannot but regard this state of constitution as a fertile source of those cardiac diseases which are seen in early life. Hence he considers it most important for the practitioner to be on the watch for the signs of this state of constitution, as, by removing it, man; young persons might be saved from the consequences of diseased heart. May the unhealthy Secretions of the Uterus afford Material for the Product1?'

1843]
Practical Remarks on Gout, fyc. 477 f Rheumatic Matter ??When the blood is infected by certain foreign matters, ymptoms are induced resembling those of a gouty or rheumatic kind. These (jef ^ matters, we have good reason to believe, are primarily derived from a a ,ect in that part of the digestive process which is performed in the stomach : duodenum. Several cases, however, have occurred to Dr. Todd which have Passed him strongly with the idea that the secretions of the uterus, if of an laf hy character, and not duly thrown off, may be absorbed into the circu-l0Q, and contaminate the blood, producing symptoms of greater or less ur-jfncy> according to the nature and quantity of the morbid secretion which may 0lV? been absorbed. A case is related, in which there seems to have been an 0nVl?Us connexion between the state of the womb and the rheumatic paroxysm, 0j. the outbreak of which the uterine symptoms were relieved. The fever was of t *?W kind, and had the appearance of one produced by the poisoned state capable of modifying the fever, without the risk of doing ulterior mischief) , opium being more effective in relieving pain. The mistura guaiaci, as emp10) by Dr. Seymour, is a most useful medicine in this affection.
A work of considerable merit.
The object of this work is stated by Mr. Wilde to be twofold : first, to a^0.^ information to the medical and general scientific reader in this country, on top of considerable importance not hitherto inquired into, with respect to the s ^ of medicine, the arrangement of hospitals and sanatory institutions, and the j1 mirable system of education and clinique in a large portion of Europe. ?econ ^ this work may be found useful as a hand-book, in its particular province, country with which we are daily becoming more and more acquainted and c nected.
We will notice a few points of interest as they arise. Division of the Medical Profession in Austria.?At present, the medical p fession in Austria is divided into the first class physicians and first class sl geons; the town and country surgeons, analogous to the general practition in Great Britain; those who practise specialities, as accoucheurs, oculists, ^ tists; the pharmaceurs, who are divided into the apothecaries and the doctors chemistry; and, lastly, the veterinary surgeons?a class very superior to a '